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Total Knee and Hip Arthroplasty in Patients Who Had Prior Septic Arthritis: A Systematic Review and Meta-Analysis
Sina Javidmehr1, Mohammad Reza Ramezanpour2, Arash Sharafat Vaziri3
1Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Background:
Septic arthritis predisposes joints to secondary osteoarthritis and complicates later arthroplasty. As arthroplasty becomes more common, surgeons increasingly encounter patients who had prior septic arthritis, yet the risk of periprosthetic joint infection (PJI) after total knee and hip arthroplasty (TKA/THA) remains unclear. This systematic review and meta-analysis assessed PJI risk in this population and examined the impact of surgical timing and procedural strategy.
Methods:
A systematic search of four online databases was conducted in October 2025 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Observational studies reporting outcomes of TKA or THA in patients who had prior septic arthritis were included. In total, 35 retrospective studies comprising 7,447 patients (4,896 knees and 2,564 hips) met the criteria. Random-effects meta-analyses were performed to estimate pooled outcomes, with subgroup and meta-regression analyses evaluating the effects of joint type, time interval from infection, and two-stage procedures.
Results:
The pooled PJI rate was 2.6% (95% confidence interval 1.4 to 4.8), with higher rates after TKA (9.8%) than THA (1.1%), although publication bias was detected in the hip cohort. Longer intervals between septic arthritis and arthroplasty were associated with lower PJI risk, whereas a higher proportion of two-stage procedures correlated with increased PJI rates. The pooled aseptic revision rate was 4.1%, and the overall complication rate was 17.1%, both higher after THA. Functional outcomes improved significantly after both procedures, with greater gains observed following THA (P < 0.001).
Conclusion:
Arthroplasty after a prior septic arthritis is associated with an elevated risk of PJI. A longer interval between infection and TJA reduced the risk of PJI, and two-stage arthroplasty was associated with a higher rate of PJI. These findings confirm an increased risk of PJI and complications after TJA in these patients, and two-stage arthroplasty does not appear to provide additional protection.
